Mastectomy Choices - All You Need to Know

Introduction

Mastectomy is a surgical procedure in which one or both breasts are removed to treat breast cancer or as a preventive measure for those at high risk of developing breast cancer. After the surgery, there are several choices that women can make to help them feel comfortable and confident with their bodies.

Why Is Mastectomy Done?

There are several reasons to choose or recommend a mastectomy. This includes:

• Breast Cancer: Mastectomy is a common treatment for breast cancer, particularly recommended for patients with large, multiple, or recurrent tumors.

• Patients with Genetic Predisposition: Women with certain genetic mutations, such as BRCA1 or BRCA2, may be at an increased risk of developing breast cancer. In such cases, a mastectomy may be recommended as a preventive measure.

• Cosmetic Considerations: Some women choose to undergo mastectomy as a part of the breast reconstruction process, which involves rebuilding the breasts for cosmetic purposes.

• Severe Breast Pain or Infection: In some cases, a mastectomy may be recommended to alleviate severe breast pain or to treat an infection that has not responded to other treatments.

What Are the Various Post Mastectomy Choices?

There are several post-mastectomy choices for those who choose to undergo a mastectomy, including

• Breast reconstruction.

• Prosthetics

• Nipple Reconstruction.

• Going flat.

Breast Reconstruction: Breast reconstruction is a surgical procedure aiming to rebuild the shape and look of the breast removed during a mastectomy. It can be performed immediately after a mastectomy or at a later time.

Breast reconstruction is mainly of two types:

• Implant-based reconstruction.

• Autologous tissue reconstruction.

Implant-Based Reconstruction: Implant-based reconstruction involves the use of breast implants to reconstruct the breast. The implants can be filled with either saline or silicone and placed above or below the chest muscle. The surgery typically takes one to two hours and requires a hospital stay of one to two days. The recovery time can take several weeks, during which patients must avoid heavy lifting and strenuous activity.

Autologous Tissue Reconstruction: Autologous tissue reconstruction, on the other hand, involves using the patient's tissue to reconstruct the breast. The tissue can be obtained from various regions of the patient’s body, including the tissue from the back, abdomen, or buttocks. However, the surgery can take several hours, and the recovery time is typically longer than that of implant-based reconstruction.

There are several reasons why a woman may choose to undergo breast reconstruction after a mastectomy:

• Restoration of body image: For many women, losing one or both breasts can be emotionally traumatic and affect their self-esteem and body image. Breast reconstruction can help restore a woman's sense of femininity and body confidence and help them feel more like themselves again.

• Improved quality of life: Breast reconstruction can also improve a woman's overall quality of life, including sexual satisfaction, social functioning, and emotional well-being.

• Symmetry and balance: Breast reconstruction can also help restore symmetry and balance to the body, especially for women who have undergone a unilateral (one-sided) mastectomy. Reconstruction can help make clothing fit more comfortably and restore confidence in social situations.

• Avoidance of prosthetics: Breast reconstruction can help women avoid the use of external breast prosthetics, which can be uncomfortable and difficult to match to the remaining breast. Reconstruction can provide a more natural and permanent solution.

While breast reconstruction can be an effective way to restore the look and shape of the breast after a mastectomy, it is important to note that it is not without risks. Potential complications can include:

• Infection.

• Bleeding.

• Donor site morbidity.

• Implant rupture.

• Pain and discomfort.

• Seroma.

• Capsular Contracture.

• Poor wound healing.

Prosthetics: Prosthetics are artificial breasts that can be worn after a mastectomy. Various materials can be used for prostheses, including silicone, foam, or fiberfill. They can be placed inside a special bra or attached directly to the skin using adhesive. Several advantages of using prosthetics include:

• Non-invasive.

• Less expensive.

• The best alternative for women who cannot opt for breast reconstruction surgery.

However, prosthetics do have some drawbacks. They can be uncomfortable to wear, and they can be difficult to find a good fit. Additionally, they can shift or move around during physical activity, which can be distracting and uncomfortable.

Nipple Reconstruction: Nipple reconstruction is a procedure that creates a new nipple after mastectomy. This procedure can be done at the same time as breast reconstruction or later. Nipple reconstruction can be done by several methods, including skin grafting, tattooing, and nipple sharing (a small piece of nipple tissue is taken from the remaining breast).

Nipple reconstruction can help women feel comfortable with their bodies after mastectomy, as it restores the breast's natural appearance. However, some women choose not to undergo such a procedure because they prefer the look of their breasts without nipples or because they do not want to undergo additional surgery.

Embracing the Body as It Is: Going flat, or choosing not to undergo breast reconstruction or wear prosthetics, is another option many women choose after a mastectomy. This choice can empower some women, allowing them to embrace their new bodies and move on after the surgery. Going flat can also be a practical choice for some women. It is a low-maintenance option, as there is no need for surgery or prosthetics. It can also be less expensive than other options. Additionally, going flat can help women avoid some of the potential complications associated with reconstructive surgery, such as infection or implant rupture.

However, there are also some disadvantages to this option. For example, some women may feel self-conscious or uncomfortable with their appearance after mastectomy and may find adjusting to their new body image difficult.

What Are the Factors Considered in Choosing a Post Mastectomy Option?

The decision-making process for post-mastectomy choices is complex and involves consideration of several factors that are unique to each individual.

Some of the factors that may be evaluated during the decision-making process:

• Health Status: The woman's overall health status is evaluated to determine if she is medically fit for surgery, reconstruction, or other treatments.

• Cancer Stage: The cancer stage, including the size and location of the tumor, is considered when deciding on treatment options.

• Treatment Options: The woman is informed of all available treatment options, including mastectomy, lumpectomy, radiation therapy, chemotherapy, and hormonal therapy.

• Personal Preferences: The woman's personal preferences and goals are considered, such as her desire for breast reconstruction, cosmetic results, and the impact of treatment on daily life.

• Emotional and Psychological Factors: The woman's emotional and psychological state is evaluated to ensure that she is mentally prepared for the decision-making process and the physical changes that may result from treatment.

Conclusion

It is important to note that a mastectomy is a major surgical procedure that can have physical, emotional, and psychological effects on the patient. Therefore, it is important for patients to discuss the various options with their healthcare provider and carefully consider the risks and benefits of the procedure before making a decision.